Survey Of Practices Research Articles

Lymph Node Sampling in Pediatric Renal Tumors: Survey of Current Practices and Impact of Education

ObjectiveTo characterize how often and to what extent surgeons are willing to perform retroperitoneal node sampling (RPLNS) for a unilateral renal tumor, and whether they would be encouraged to change goal number of LNs after “targeted education” (TE) MethodsA survey with selected demographic and LN sampling practice questions was distributed to practicing members of the Society of Pediatric Urology (SPU). After answering a seven-question questionnaire, participants were provided with an abstract on the adequacy of LN yield for staging. This served as the TE and then participants were asked to answer a final question on LN sampling goals. ResultsA total of 76 (19.2%) of participants, out of 395 invitations, returned complete surveys. Cross tabulation between sampling goals before and after TE showed that among surgeons sampling 1-4 nodes, 13/24 (54.16%) would be willing to change their practice and sample ≥10 nodes. A higher proportion of participants who were already systematically surveilling 5-9 LNs would be willing to change their current practice: 30/39 (77%) would now aim for ≥10 LNs. On multivariate analysis, only willingness to sample ≥5 LNs in current practice was predictive of changing to sample ≥10 LNs after TE. ConclusionRetroperitoneal LNs are currently still under sampled by pediatric urologists operating on children and adolescents with unilateral renal tumors. Targeted education appears to encourage change in LN sampling practices.

Position of Beta-blockers in the Treatment of Hypertension Today: An Indian Consensus.

Management of essential hypertension (HTN) remains challenging, with contemporary control being achieved in <1/10 of the cases, especially when aligned with the recently updated guidelines of American College of Cardiology (ACC) or International Society of Hypertension (ISH). The place and positioning of beta-blockers have been evolving, with recent focused updates, such as the European Society of Hypertension (ESH) 2023 guidelines, that may hold relevance for the Indian phenotypic traits of premature cardiovascular disease (CVD), fragile coronary architecture, and/or high resting heart rate. To further develop consensus on the clinical role and relevance of beta-blockers, including nebivolol, an Indian consensus was evolved with graded recommendations on their clinical role in HTN, HTN with additional cardiovascular (CV) risk, or type 2 diabetes mellitus (T2DM). An expert review panel was constituted, comprising interventional and clinical cardiologists as experts, to synthesize the literature for the development of a validated knowledge, attitude, and practice (KAP) survey questionnaire. Research databases, including Cochrane Systematic Reviews, PubMed, and Google Scholar, were accessed for contemporary information and guidelines on beta-blockers updated until Dec 2023. Delphi rounds were conducted to develop graded recommendations based on the strength, quality of evidence, and the agreement among the panelists (n = 9). Consensus was achieved on the graded recommendations, with ≥70% of national panelists in agreement. Ninety-six percent of respondents opined that the new ESH HTN guidelines (2023) help gain confidence in using beta-blockers, which are considered first-line drugs for the treatment of HTN. Beta-blockers, including nebivolol, can be recommended in patients with HTN with high resting heart rates, including young hypertensive patients under 40 years of age. For people under 60 years old with HTN, regardless of whether they have comorbid diseases, beta-blockers are the recommended drug choice. Ninety-five percent of respondents opined that nebivolol is the preferred beta-blocker in hypertensive patients with T2DM, followed by bisoprolol and metoprolol. More than 90% of respondents opined that the three most commonly preferred beta-blockers by experts in patients with angina were nebivolol, metoprolol, and bisoprolol. Beta-blockers, including nebivolol, can be considered initial-line therapy for HTN management in real-life settings in India and nebivolol is preferred because of its two important properties: highest beta-1 selectivity and endothelial-dependent vasodilation.

Digital Twins in Manufacturing: A Survey of Current Practices and Future Trends

Digital Twin (DT) is the advanced tool of smart manufacturing which provides a proper way to model, analyse, and control the physical systems. A DT is the lifelike rendition of a physical object or phenomenon that uses real-time actual phenomena data to depict its actions, efficiency, and responses within the surrounding context. This technology allows electronic manufacturers to obtain a real-time stream of their systems, in which predictive maintenance, increased operation effectiveness, and improved product quality can be attained. By developing an ever-evolving replica of the physical structures, systems or even operation lines, Digital Twins enable the functionality of exploring various demanding circumstances and schemata, all in order to make effective decisions. When the manufacturing environments are rapidly changing, and there are more interconnections between them, the use of Digital Twins is especially useful. They continue improvement by highlighting problems, forecasting failure, and making choices based on data. The purpose of this article is to examine smart manufacturing via the lens of IoT DT technology. It gives general information about its uses, such as in the processes, time-saving and safety measures. As well, the paper considers the difficulties related to the practical application of DT, including costs, data management, and requirements for the formation of standards. Thus, based on analysing future developments and the role of Digital Twins as an innovation enabler in different industries, this study can benefit scholars, practitioners, and politicians who look forward to unlocking the potential of this innovative solution.

Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.

Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures. A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates. Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months). Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.

Assessment of “Knowledge, attitudes and practice” of the population of the Republic of Tajikistan regarding COVID-19

Introduction. Despite the high level of vaccination, some groups of the population still lack reliable information about vaccines and resources with which to familiarize themselves with it. Social and behavioral changes are a key element of an effective response to COVID-19, such as increasing the level of knowledge of the population through the dissemination of information and educational materials on vaccination of the population against coronavirus infection. The purpose of the study: to assess the level of knowledge about COVID-19, behavioral practices, as well as attitudes towards vaccination and other ongoing anti-epidemic measures among the population of the Republic of Tajikistan. Materials and methods. The study was conducted by the NGO “Subhi Tandurusti” from February to May 2024. To assess the level of respondents in the Knowledge, Attitudes and Practices survey regarding issues related to COVID-19, a questionnaire survey was conducted using a specially designed questionnaire. The study involved 2,500 respondents from 15 different districts and cities of the republic. Results. About 93 % of respondents (n = 2322) correctly answered this question regarding modes of transmission of the virus, indicating a high level of awareness of modes of transmission of COVID-19. Relatively high rates of correct answers were recorded to the question “Is it possible to get sick with COVID-19 several times?” 69.5 % of respondents (n = 1737) answered this question correctly, indicating an understanding that it is possible to get sick with COVID-19 several times. Attitude of respondents regarding the safety and effectiveness of vaccination: 78.3 % of respondents (n = 1957) expressed confidence in its safety, 11.3 % (n = 282) did not know the answer, and 10.4 % (n = 261) did not consider the vaccine safe. 2,430 people (97.20 %) have already received the full course of vaccination against COVID-19, 42 people (1.68 %) have only received the first dose of the vaccine and are planning to receive the second. The most popular source of information about COVID-19 was television programs – 44.0 % of respondents (n = 1101), followed by information materials (25.2 %, n = 631) and the Internet, including websites and social networks (22.8 %, n = 571). At the same time, 75.6 % (n = 1889) of respondents rated information and educational materials about COVID-19 as very useful and reliable. To the question “Have you been tested?”: 639 people (25.6 %) “never” got tested, 588 (23.5 %) “often” and 461 (18.4 %) “always” got tested. Conclusion. The results of the study showed that the interviewees had sufficient knowledge about COVID-19, including the transmission of the virus through various routes and clinical symptoms of the disease, as well as the importance of vaccination. Public health initiatives help better protect public health during emergencies such as infectious disease pandemics.

Policy palette: A spectrum of legal and educational challenges in the political landscape

The creation of points where law, politics and education policies take intersection is a very complex and dynamic environment determined by philosophical shifts, economic problems, and social dynamics. This study dissects various complicated challenges facing the process of the framing of educational policies and their implementation which have become rampant due to the rapid political transformations. The researched evaluation is applied via both qualitative and quantitative methods, including juridical research, case and best practices studies and surveys, with the descriptive nature of the research as the main tool. The heart of the essay is three main themes - the contention between the rigidity of the academic standards and the holistic growth of students, its possible effects when students are too identified with a test-centric approach as their knowledge is sacrificed for their test scores, and the inclusion of rights and protections for underrepresented populations even when faced with a government’s resistance. Similarly, the research examines the perils of creating legislation too quickly, especially, because of unexpected side effects and interpretation conflicts. Findings show profound demographic differentials over districts which implies the designing and implementation of policies need to be modified accordingly. Unless a certain policy brings the best outcomes in the learning process, then nobody should choose it even if it means disrupting student well-being and decreasing their involvement. It is also emblematic of how cross-party cooperation and stakeholders’ understanding are important aspects of fairly dealing with complicated policy environments.

Describing Community-Based Nurses' Knowledge, Attitudes, and Practices in the Nutritional Care of Older Adults: Results of a UK Survey.

To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom. A descriptive cross-sectional, anonymized, online survey of nurses' knowledge, attitudes, and practices related to older adults' nutrition was developed. Community-based nurses working with older adults in the United Kingdom were recruited via social media and convenience sampling. Responses were received from 194 community-based nurses. Nutritional care was seen as a multidisciplinary responsibility by 62% of participants. Most undertook nutrition screening (93%), were confident in providing nutritional advice (83%), and ease of identifying those in need (88%) was high. However, some aspects of nutritional knowledge were less complete, including recommended daily intakes of protein (60% unsure) and fiber (52% unsure). High confidence in delivering nutritional advice contrasted with uncertainty around some aspects of nutritional knowledge, suggesting opportunities to improve training on the nutritional needs of older adults. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

A French Preoperative Cholesteatoma Management: Current Preoperative Consultation and Tendencies.

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended questions and 1 open-ended question. Seven questions concerned the participants' characteristics and 2 questions concerned the physiopathology of cholesteatoma. Nine questions focused on surgical information, six questions focused on the procedure modalities and ten questions focused on the risks of complications from the intervention. Results: Eighty-two surgeons answered the survey. In 75% of the cases, an information form written by a professional society was provided. The risk of recurrence or residual post-operative cholesteatoma was systematically stated in 78% of cases (n = 64), while the risk of aesthetic sequelae was only stated in 1% (n = 1). Participants working in a university hospital were more likely to inform patients about the risks of vertigo (p = 0.04), aesthetic risks (p = 0.04), poor functional outcomes (p = 0.04), surgical revision (p = 0.05) and the risk of peripheral facial paralysis (p = 0.05). Surgeons who mainly practiced otology were more likely to inform patients about the risks of recurrence and/or residual cholesteatoma (p = 0.02) and taste disturbances (p = 0.02). Conclusions: Cholesteatoma surgery was well explained to patients during the preoperative consultation, mostly with written support, even if the information given was not the same for all complication risks. It could be useful to create an information form dedicated to cholesteatoma surgery to improve comprehensive information and maintain a trustworthy relationship with patients.

Memory of Soviet Repressions in the Kazakhstan Lithuanian Diaspora: Interpretations, Practices, Contexts

In this article, the focus is on the memory of repressions in the Kazakhstan Lithuanian diaspora, a large part of which consists of the descendants of Lithuanians who were subject to repression. Based on data from a survey of semi-structured interviews, the interpretations, evaluations, and practices for the memorialisation and commemoration of the memory of the repressions among the representatives of the diaspora are analysed. The connections of this memory with Kazakhstan’s dominant collective memory discourses and the Lithuanian narrative of the memory of repressions are discussed. The analysis reveals how discourses of the memory of the repressions in the country impact the memory of the descendant of the migrants.

Police interviewing in Taiwan: A self-report survey of practices and beliefs

ABSTRACT Following upon a prior survey of 631 North American law enforcement officers, and in light of heightened concerns about false confessions, we assessed the interrogation practices and beliefs of 551 police investigators in Taiwan. Overall, participants estimated that they were 66% accurate at truth and lie detection, that 48% of suspects waived their rights, that they elicited self-incriminating statements from 75% of all suspects, and that 27% of suspects confessed in the presence of their attorney. Of particular note is the self-report by participants that 72% of their interrogation sessions were fully recorded. With regard to the use of various interrogation techniques, participants estimated that they often identified contradictions in the suspect’s story, confronted the suspect with actual evidence, appealed to the suspect’s self-interests, and isolated the suspect from family and friends. We discussed the consistency of our findings with prior research, addressed potential shortcomings, and made recommendations to future directions.

Abstract B115: Intensive Course in genetic cancer risk assessment: Empowering clinicians, expanding clinical knowledge, and elevating care in underserved populations

Abstract Background: Despite efforts to integrate genetic cancer risk assessment (GCRA) services into mainstream medicine, the dearth of healthcare providers adequately trained in clinical cancer genetics remains a significant barrier to care, particularly in underserved communities. Since 2001, City of Hope has helped address this need through a distance mediated lntensive Course (IC) and Clinical Cancer Genomics Community of Practice (CCGCoP), with a focus on training and supporting clinicians who deliver care to underserved patient populations. Here we report on the reach, education, and practice outcomes from the past five annual cohorts of the IC in its pursuit to expand GCRA care to underserved areas and minority populations. Methods: Practice catchment area and patient population data were collected on the course application. Cancer genetics knowledge was assessed at baseline and immediate post-course; professional self-efficacy and practice changes were measured at baseline, immediate, and 12 months post-course. Results: Of 762 participants from five IC cohorts (2020-2024), 566 (74%) indicated they provide all or part of their care in an underserved area and/or to minority populations; 55 (10%) practice outside the U.S. Of these 566 clinicians, mean pre-to-post course knowledge scores increased 59%, and mean pre-to-post self-efficacy scores increased by 38%. Of 195 participants who completed a one-year post-course practice survey, 68 (35%) did not practice GCRA at baseline, of whom 61 (88%) reported implementing GCRA into their practice one-year post-course. Of 126 participants who were practicing GCRA at baseline, 55 (44%) reported an increase in their GCRA patient volume at one-year post-course. Open-ended feedback revealed that participants highly valued IC training and ongoing CCGCoP support for building and sustaining their GCRA skills, resources, and practices. Conclusions:Results demonstrate the efficacy of distance-mediated training and ongoing practice support in enhancing clinician competencies and knowledge of practicing GCRA therefore increasing access to GCRA services for underserved and minority patient populations. Efforts are underway to leverage the resources of the IC and CCGCoP to develop a more flexible, cost-effective course model and collaborate with champions to increase access to best practices in GCRA in diverse underserved settings across the US and internationally. Citation Format: Dev Tanna, John Luna, Alex Capasso, Kathleen Blazer. Intensive Course in genetic cancer risk assessment: Empowering clinicians, expanding clinical knowledge, and elevating care in underserved populations [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B115.

Farm dams and the need for integrated water storage safety, equity and land-use policy: Comparative case study evidence from Australia

Farm dams that are not planned, designed and managed properly at the individual level can create water storage safety, equity and land-use planning threats to downstream communities and the environment that aggregate at the catchment level. The paper extends previous research and understanding into this threefold phenomenon by exploring the integrated policy needs within the Australian setting. This is achieved through comparative case studies involving assessments of farm dam policies and their integration, and on-site audit-style surveys of dam management practices that are related to the policies in two state jurisdictions, South Australia and Tasmania. These case studies represent weak versus strong farm dam safety, equity and land-use regulatory policies and integration. Survey results in South Australia find most hazardous farm dams studied are not built or maintained to an adequate standard and spillways are blocked and/or under-designed. This results in potentially storing more water than entitled and creating unsafe dams and potential water sharing equity and land-use planning threats at both the individual and cumulative levels in catchments. Survey results in Tasmania are in contrast and hence this state serves as an exemplar of feasible 3-fold integrated policy that is performing effectively. Analysis of results against international regulatory benchmarks finds that in addition to Tasmania's model there are other regulatory options that may better suit different jurisdictions, and cost-effective tools to help integrated policy implementation are also available. Based on these findings policy recommendations for South Australia are made. The paper represents indicative lessons and guidance for any jurisdiction internationally with similar circumstances on how to design suitable integrated policy that helps farm dams and proximate land-use be developed and managed safely and equitably.

Medical examiner service in children’s deaths: a survey of current practice in paediatric intensive care units in England and Wales

IntroductionA statutory system of medical examiners (ME) was introduced in England and Wales in September 2024. The next of kin will be given the opportunity to speak to the ME...

Vaccination strategies for patients with lymphoma treated in early lines of therapies: a real-world practice survey among Fondazione Italiana Linfomi centers

Patient diagnosed with lymphoma presents a greater risk of infection, mainly if undergoing anti-CD20 therapy, splenectomized, hypogammaglobulinemic. They can therefore benefit from a vaccination program, especially in the watchful waiting phases or before starting oncologic treatment. The COVID-19 pandemic has raised awareness on vaccinations in frail patients, but a homogeneous approach has yet to be achieved across different vaccinations. In this sense, FIL researchers conducted a multicenter survey to evaluate the attitude of hematologists to anamnestically evaluate the patient’s vaccination history and to plan vaccinations before treatments. In this work we present the results of the survey which denote attention to the topic but not homogeneous behavior regarding the proposal and timing of vaccinations.

Procedural Integrity in Applied Settings: A Survey of Training, Practices, and Barriers

Procedural Integrity in Applied Settings: A Survey of Training, Practices, and Barriers

An exploration of UK speech and language therapists' treatment and management of functional communication disorders: A mixed-methods online survey.

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care. What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.

Sexuality after breast cancer treatment: A physician’s survey of current clinical practice

BackgroundSide effects of breast cancer treatment (BCT) impact patients’ general and sexual wellbeing. Sexuality related complaints are reported by 70% of breast cancer survivors mainly due to the genitourinary syndrome of menopause (GSM). In clinical care, sexual side effects are often un(der)detected because physicians as well as patients experience barriers to discuss sexuality-related issues. Materials and methodsWe composed an online survey ourselves using known definitions about sexuality and menopause and known factors for not discussing sexuality. We used multiple-choice questions with a Likert scale to optimize interpretation of the statements. 64 practitioners completed the survey. With this online survey, we examined physicians’ knowledge of −and attitude towards- sexual wellbeing and detection and treatment of GSM in breast cancer survivors (BCS). ResultsVaginal dryness and dyspareunia were the symptoms most associated with menopause (n = 63/64 (98 %) and n = 56/64 (87 %)) and sexuality (n = 63/64 (98 %) and n = 61/64 (95 %)). These 2 complaints were also the most discussed symptoms of menopause (vaginal dryness n = 51/64 (80 %) and dyspareunia n = 45/64 (70 %)). The main reason to not discuss these issues were absence of reporting GSM (n = 40/64 (62 %)) and absence of a direct cause to discuss GSM (n = 35/64 (55 %). 64 % (n = 41/64) of practitioners don’t feel sufficiently educated to discuss and treat GSM. They proposed vaginal estrogens to treat GSM as first or second line respectively in 12 % (n = 8/64) and 46 % (n = 30/64) of symptomatic BCS. DiscussionAlthough sexuality related complaints are common in BCS, 64% of all participating physicians feel they are not adequately trained to handle them. More attention towards training of physicians is needed to discuss GSM related complaints also when they are not spontaneously reported by a patient and with clear guidance towards the medical treatment of GSM in BCS.

Undergraduate rheumatology teaching in the UK: a survey of current practice by teachers and students.

The last major UK survey of medical undergraduate rheumatology teaching was 25 years ago. This study aimed to describe current teaching practice, the perceptions of teachers and students and their engagement with Versus Arthritis teaching resources and future challenges and opportunities. Electronic surveys were distributed by e-mail and/or social media to relevant teachers and students identified within all 37 UK medical schools. A total of 34/37 (91%) teacher and 30/37 (81%) student surveys were returned. Compared with the last survey, the proportion of schools delivering rheumatology-identifiable teaching has fallen from 100% to 86% and the mean number of teaching days from 30 to 10. Rheumatology teaching is now more dispersed throughout the curriculum. Students preferred active learning methods such as simulation and expert patient teaching, while teachers preferred small-group teaching, online learning and lectures. The Versus Arthritis resources appeared underutilized by students but were considered useful. Most students thought rheumatology careers were not promoted within their medical school. A decrease in dedicated rheumatology teaching time was noted since the last survey 25 years ago. Greater promotion of rheumatology as a speciality and future career is required to maintain its professional identity and prevent marginalization.

Deferred Cord Clamping in Twin Pregnancies Across Canada: A National Survey of Practices

ObjectiveGuidelines recommending deferred cord clamping (DCC), delaying cord clamping for at least 30 seconds post-birth, have shown significant benefits in preterm singleton births. However, evidence supporting DCC in twins is scarce due to limited trial data, leading to practice variations. This study aims to assess current reported DCC practices for twin pregnancies in tertiary hospitals across Canada. MethodsA web-based survey was distributed to neonatologists and obstetrician investigators associated with the Canadian Neonatal and Preterm Birth Networks operating maternity and neonatal units. ResultsThe site response rate was 93% (28/30 sites), with 83% (25/30) for neonatologists and 56% (17/30) for obstetricians. The majority had a local protocol for twin pregnancies (obstetricians 13/17, neonatologists 21/25). While all centres practised DCC in dichorionic-diamniotic twins, a difference was noted for monochorionic-diamniotic twins, with 56% of neonatologists and 65% of obstetricians performing DCC. During cesarean delivery, most obstetricians (76.5%) placed the firstborn on the mother’s thighs. Neonatologists varied in their practices, with 32% placing the baby on the mother’s abdomen, 32% on the mother’s thighs, and 28% holding the baby at the height of the perineum. Divergent opinions were observed regarding contraindications, including risks of postpartum hemorrhage and velamentous cord insertion. ConclusionsDCC is reported to be practised in most twin deliveries among Canadian Neonatal and Preterm Birth Network centres. However, there are wide variations in practice, especially concerning the characteristics of the twins in which DCC is performed. Future research should investigate optimal cord clamping management in twins to standardize practices and maximize benefits.

A Perception Survey of Lean Management Practices for Safer Off-Site Construction

Lean practice is recognised for having a great potential in promoting safety risk management in off-site construction (OSC). This paper presents results of a study conducted to assess the impact of lean practice on safety risk management in OSC in a developing country. A quantitative approach using a survey-based questionnaire was adopted. Lean management practices (LMPs) identified from a literature review were empirically tested using a sample survey of 103 OSC contractors. The survey responses were subjected to descriptive and inferential statistics. The top ranked LMPs for safety risk management in OSC included two mistake-proofing practices, i.e., use of personal protective equipment (PPE) and use of hazard warning equipment; two last planner system (LPS) practices, i.e., involvement of workers in safety planning and providing necessary working equipment; and one first run studies (FRS) practice, i.e., critical analysis of work methods. These LMPs are useful in controlling high-consequence safety risks in OSC. Based on evidence found in this study, the paper argues that lean practice can bring great value to safety risk management in OSC in countries where OSC is transitioning.